Scoliosis

Scoliosis is a condition where the spine curves sideways in an “S” or “C” shape. It’s a musculoskeletal disorder that most commonly affects children and adolescents, though milder cases can sometimes go unnoticed until adulthood. This condition can vary in severity, with some people experiencing minimal symptoms while others may develop more significant spinal deformities.

Relevant Anatomy

The spine, also known as the vertebral column, is made up of a series of bones called vertebrae. These vertebrae are stacked one on top of the other and are separated by discs that act as cushions. In a healthy spine, these vertebrae form a straight vertical line when viewed from the back. However, in scoliosis, the spine curves sideways, often rotating slightly as well. This can cause a visible deformity, leading to uneven shoulders or hips and a noticeable imbalance in the torso.

Signs and Symptoms

The signs of scoliosis can vary depending on the degree of curvature, but they are often noticeable through physical examination. Key signs include:

• Uneven shoulders
• One shoulder blade protruding more than the other
• One side of the rib cage protruding more than the other
• One hip sitting higher than the other
• A shift of the waist
• A difference in leg lengths
• A prominence on one side of the back when bending forward

Symptoms may include:

• Back pain: Although scoliosis is not typically painful in children and adolescents, adults with the condition may experience chronic backaches.
• Difficulty breathing: In more severe cases, the curvature can compress the lungs and affect breathing.
• Local muscular aches: Muscles on one side of the back may become strained as they work harder to compensate for the spinal misalignment.

Causes

The cause of scoliosis is often unknown, and when this is the case, it is referred to as idiopathic scoliosis— accounting for 80% of cases. However, scoliosis can also be linked to certain medical conditions, including:

• Cerebral palsy: A neurological condition that affects muscle control, which can lead to uneven growth and development of the spine.
• Muscular dystrophy: A group of genetic disorders that weaken the muscles, leading to poor spine support and abnormal curvature.
• Marfan syndrome: A connective tissue disorder that can cause skeletal abnormalities, including scoliosis.

Scoliosis may also occur due to congenital defects in the spine, previous spinal surgeries, or traumatic injuries.

Diagnosis

A diagnosis of scoliosis begins with a physical examination, where a healthcare professional assesses for asymmetry in the shoulders, hips, and ribs. The Adam’s forward bend test is often performed, where the patient bends forward at the waist while the examiner looks for abnormal spinal curves or rib cage prominence.

The diagnosis is confirmed with X-rays, which can determine the severity of the scoliosis by measuring the Cobb angle. This angle quantifies the degree of spinal curvature and is essential for monitoring the condition over time. The Cobb angle also plays a role in treatment decisions, as different degrees of curvature are associated with different management approaches.

Grading

Scoliosis is graded based on the severity of the curve, as measured by the Cobb angle.

Prognosis

The prognosis for scoliosis depends largely on the severity of the curve and the age at diagnosis. Children and adolescents diagnosed early and with mild curves tend to have better outcomes with less likelihood of curve progression. Regular monitoring is essential, especially during growth spurts when curves can worsen.

In adults, progression is less likely but may still occur, particularly if scoliosis was not treated during childhood or adolescence. With proper management, most people with scoliosis can lead normal, active lives. In severe cases, especially where the curve impacts respiratory function, more intensive interventions may be needed.

Treatment

Treatment for scoliosis is based on the severity of the curve and the individual’s age. The primary goals are to stop curve progression, manage symptoms, and improve function. The main treatment options are:

Physiotherapy

Physiotherapy plays a significant role in managing scoliosis, particularly in mild to moderate cases. The aim of physiotherapy is to:

• Improve muscular endurance
• Increase coordination and control
• Correct posture and side shifts

One well-known physiotherapy approach is the Schroth method, which is a scoliosis-specific exercise regime designed to:

• Promote muscular symmetry
• Improve postural awareness
• Help with ease of breathing
• Optimise movement patterns and overall function

Several studies support the Schroth method, demonstrating improvements in back strength, respiratory function, and a reduction in the likelihood of needing surgical interventions.

In addition to the Schroth method, other physiotherapy interventions may include:

• Core strengthening exercises: To enhance the stability and support of the spine.
• Stretching routines: To improve flexibility and reduce muscle tension on the concave side of the curve.
• Breathing exercises: To improve lung function, especially in cases where the rib cage is compressed.

Bracing

For moderate scoliosis (20–40 degrees), an orthopaedic specialist may recommend wearing a back brace. Braces help to stop the curve from worsening, particularly in children and adolescents who are still growing. The most common type of brace is the thoracolumbosacral orthosis (TLSO), which fits around the torso and must be worn for most of the day to be effective.

Surgery

Surgery is typically reserved for severe scoliosis (curves of 40–50 degrees or more) or for cases where the curve is rapidly progressing despite other treatments. The goal of surgery is to correct the spinal curvature and stabilise the spine. The most common surgical procedure is spinal fusion, where metal rods, screws, and bone grafts are used to fuse the curved part of the spine into a straighter position. While surgery can significantly reduce the curve, it is a major procedure and carries risks, so it is only recommended when absolutely necessary.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.

References

Burger, M., Coetzee, W., du Plessis, L. Z., Geldenhuys, L., Joubert, F., Myburgh, E., van Rooyen, C., & Vermeulen, N. (2019). The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. The South African journal of physiotherapy, 75(1), 904. https://doi.org/10.4102/sajp.v75i1.904

Janicki, J. A., & Alman, B. (2007). Scoliosis: Review of diagnosis and treatment. Paediatrics & child health, 12(9), 771–776. https://doi.org/10.1093/pch/12.9.771

Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., Diers, H., Grivas, T. B., Knott, P., Kotwicki, T., Lebel, A., Marti, C., Maruyama, T., O’Brien, J., Price, N., Parent, E., Rigo, M., Romano, M., Stikeleather, L., Wynne, J., … Zaina, F. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders, 13, 3. https://doi.org/10.1186/s13013-017-0145-8

Seleviciene, V., Cesnaviciute, A., Strukcinskiene, B., Marcinowicz, L., Strazdiene, N., & Genowska, A. (2022). Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice. International journal of environmental research and public health, 19(15), 9240. https://doi.org/10.3390/ijerph19159240